Are My Postoperative Symptoms Normal?

This page discusses common symptoms after cataract surgery.

Symptoms of concern

Let’s start with symptoms of concern. These are not common.  If you notice any of the following symptoms, you should take them seriously and contact your doctor immediately for advice, day or night.

 

1. It is two or more days after surgery and your eye becomes red, painful, and your vision drops.  Light bothers your eye.  You were fine a day ago.  

2. A dull, constant and increasing ache develops over hours or days, and vision goes down; it becomes foggy or hazy.

3. You are experiencing new flashes that you can see in the dark, and new floaters.

These symptoms can be vision threatening and may need to be treated quickly, even if you are seeing well.  They can occur even after straightforward surgery, but they are more likely to occur if you experienced a complication.

For a discussion of complications during and after surgery, click here.

Common observations after cataract surgery

 

Images are jiggly 

It takes a month or so for your new lens to completely settle in to a fixed position inside your eye.  For a few weeks, the lens will jiggle a little bit every time you move your eye.  This is harmless.  It usually stops after about a month.

Floaters  

Probably normal, but see signs of concern above.  Floaters are usually caused by debris in the vitreous cavity.  Everyone has some floaters.  Sometimes you can notice preexisting floaters in more detail after cataract surgery.  Or your old floaters may move a bit, in or out of view.  Floaters are usually harmless, even if they are annoying.   However, if you see a significant number of new floaters, or new floaters along with flashes, you need to be evaluated urgently for a retinal detachment.  Retinal detachments are relatively unusual, but can occur even after uncomplicated cataract surgery. 

 

Red eye

Immediately after surgery:  this is most likely just a blood spot, and is harmless.  Blood spots on the white of the eye (subconjunctival hemorrhage) are very common.  Sometimes they can be quite large.  They are still not a problem.  They will go away in a couple of weeks.  

 

A week or two after surgery, red eye can be caused by allergy to eyedrops.   Red eye can also be caused by inflammation that needs to be treated.  Call your surgeon if your red eye is also painful, and light bothers you. 

Sensitive to light

Sometimes it can take a bit to get used to all the light that pours in after cataract surgery.   This type of light sensitivity is normal.  You might notice it on the first day after surgery.  Two or more days after surgery, if you notice new light sensitivity, especially if it seems to be getting progressively worse and the eye is newly red, call your doctor immediately.

Pupil is dilated

Cataract surgeons use strong dilating drops.  You may be dilated at least a little bit for up to a week after surgery.  This effect is especially noticeable if you have blue eyes.  Your pupils may have different sizes for a few days.

Images are different sizes between two eyes

This often occurs after the first eye has had surgery, and before the second eye has surgery.  The image size disparity almost always resolves after surgery on the second eye.  If you have had cataract surgery in both eyes and images still have different sizes, let your surgeon know.

 

Images are a different color between the two eyes

You may notice this after the first eye, but before the second eye is taken care of.  Cataracts often put a yellow tint on everything.  The colors you are seeing after cataract surgery through your new clear lens are the ‘real’ colors.  Rarely, you may notice a color disparity between the two eyes even after both eyes have had surgery.  If this is the case, discuss your symptoms with your surgeon.

Vision is a little worse at 1 week than it was at 1 day after cataract surgery

This may just be a shifting of focus of the eye.  It may seem to make your vision worse, when in reality the best focal distance is just moving in or out- like a camera refocusing.  Check your vision at several distances to see if this is what is happening.  

 

If your vision has dropped significantly at all distances, or the drop in vision is occurring along with ache, pain or redness, call your doctor immediately.

Images have streaks or ghosts

A common cause for this is astigmatism.  Discuss your symptoms with your doctor to see if this is expected in your case. 

There is a shadow off to the side

Most surgeons operate from the side.  This causes a little bit of extra corneal edema (swelling) at that location.  This edema creates a blind spot, or a sense of fogginess off to the side.  This special temporary blind spot can take 2-4 weeks to go away.

It's a month after my surgery and there is still a shadow off to the side:  This is probably not edema.  Mention this to your surgeon.  He or she may need to examine you and take further history to determine the cause of this.

There is a glint, like a flash, occasionally in bright light

Sometimes light can bounce off of the outer edge of the artificial lens.  These flashes occur in the presence of light. Flashes in the dark, when there is no external source of light, can be a sign of traction on the retina.  So if you see flashes, the first question to ask yourself is whether you see them when there is light present, or whether it is dark. Close you eyes to see if they persist.  If they occur in the darkness, there is more cause for concern.

 

People can see my lens reflecting back at them

This may be especially noticeable when you are still dilated in the first few days after surgery.  It is harmless and usually becomes difficult for others to see after the first week.  If you have blue eyes, you may be dilated for several days after surgery.

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